[Theoretical bases for the proposal of a randomized, controlled, open label clinical trial to assess the efficacy of adding bemiparin to the icodextrin solution in patients on peritoneal dialysis with peritoneal transport disorders [FRIAT-BEM-2005-01]].
Multiple investigations performed on peritoneal pathophysiology during peritoneal dialysis (PD) suggest that intraperitoneal heparin might modify most of the causes of membrane deterioration. The actions described favouring this idea are: 1) Peritoneal Chronic inflammation alters peritoneal function and hepraine has anti-inflammatory properties. 2) Peritoneal fibrosis related to peritoneal dialysis or traumatic injury may be avoided or limited with heparin. 3) Heparine induces tPA synthesis by mesothelial cells, which represents a potentiation of fibrinolytic action. 4) Heparine, specifically low-molecular weight heparin, inhibits angiogenesis. 5) Intraperitoneal heparin favors the removal of advanced glycosilation end products in PD. 6) Animal models and clinical studies with small series of patients have demonstrated an improvement of peritoneal function with intraperitoneal heparine use. 7) Until now, no adverse effects of the intraperitoneal heparin use have been found. In consequence, it is a plausible hypothesis to consider that intraperitoneal heparin may favourably modify peritoneal function in patients under peritoneal dialysis.
Selgas
R
R
Servicio de NefrologíaHospital Universitario La Paz Castellana, 26128046, Madrid. rselgas.hulp@salud.madrid.org
Del Peso
G
G
Sánchez Villanueva
R
R
Aroeira
L S
LS
Fernández Perpén
A
A
Ortiz
A
A
Ruiz Ortega
M
M
Sánchez-Tomero
J A
JA
Martínez
J
J
Marrón
B
B
Bajo
M A
MA
D005936:Glucans / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D015312:Hemodialysis Solutions; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D000077607:Icodextrin; D008659:Metabolic Diseases / Q000188:drug therapy*; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism*; D016032:Randomized Controlled Trials as Topic
D005936:Glucans; D015312:Hemodialysis Solutions; D006495:Heparin, Low-Molecular-Weight; D000077607:Icodextrin; D005947:Glucose; C411345:bemiparin